Study Finds Left and Center of Cranium Exposed to Greater Radiation in Invasive Cardiologists

Invasive cardiologists may experience greater radiation exposure on the left and center of the cranium compared to the right side, according to a study published Aug. 17 in the JACC: Cardiovascular Interventions. The study also found that wearing a non-lead cap layered with barium sulfate-bismuth oxide (XPF) may reduce exposure.

In the BRAIN study, a single-center, prospective study, researchers examined the ionizing radiation exposure to operators of invasive cardiovascular procedures. The study population included eleven operators – three interventional cardiology fellows, four general cardiology fellows and four attending physicians (38.4 ±7.2 years of age; all male) – who each performed a large volume of diagnostic and interventional procedures (66.2 ±26.8). Each operator wore an XPF attenuating cap with six dosimeters inserted into the inside and outside surfaces of the cap on the right, left and center of the head. Additionally, three dosimeters were place outside the catheterization lab to measure ambient exposure.

Results showed that the total exposure on the outside left side of the head was slightly higher than exposure to the outside center, and exposure to these locations was significantly higher than the outside right location. Total exposure at inside left, inside center and inside right locations was similar. These results were similar on a per-case basis. The inside left and inside center exposures were significantly lower than the outside left and outside center locations, while the inside right and outside right locations experienced similar exposure. When compared to the control dosimeters located outside of the lab, the total exposure was 177 percent higher at the outside left location and 117 percent higher at the outside center location. The exposure was 31 percent higher at the outside right location but did not reach statistical significance. The exposure at the inside locations were non-statistically higher than the control exposure, but grouped together were 10 percent higher, suggesting that wearing an XPF cap may reduce the exposure to a level comparable to that of ambient radiation.

The authors found that the only factor that predicted the extent of exposure at the outside left and outside center locations was the level of training held by the operator. Attending cardiologists experience increased cranial exposure, mostly due to their location in the lab during a procedure. The statistically significant predictors of exposure at the outside right location were patient weight, patient BMI and percentage of radial cases.

They conclude that given recent reports of left-sided brain cancer in operators of fluoroscopically guided procedures, moving forward, greater efforts should be made to reduce exposure. Protective measures from radiation exposure include distance, shielding and time, which are mostly operator dependent. "The concept of 'as low as reasonably possible' is a cornerstone in radiation safety that is endorsed by multiple cardiology societies and should be stressed before any operator enters a cardiac catheterization laboratory and be frequently enforced," they write.

Clinical Topics: Noninvasive Imaging, Nuclear Imaging

Keywords: Barium Sulfate, Body Mass Index, Brain, Brain Neoplasms, Cardiac Catheterization, Fluoroscopy, Head, Protective Devices, Radiation, Ionizing

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